UNDP in Africa

Low-income countries are often offered special arrangements by pharmaceutical companies on medicine to treat HIV. Middle-income countries are left out of these arrangements and must address the challenge of helping their citizens access the drugs. (Photo: UNDP)

A key determinant of middle-income countries meeting their health-related Millennium Development Goals (MDGs) will be their ability to sustain and expand access to treatment for HIV and its co-infections, like TB and Hepatitis C.

By 2020, the majority of people living with HIV will be living in middle-income countries, such as South Africa, Brazil, Russia, Ecuador and Thailand. Yet at the same time as new, more effective medicines to treat HIV emerge, many of these countries, based on their average income levels, are increasingly being left out of special arrangements offered by pharmaceutical companies to low-income countries, such as price discounts or voluntary licenses to use their patents.

For instance, in 2011, using Global Fund grants, HIV medicine Darunavir was offered to Sub-Saharan African countries at US $1,095 per patient per year. Meanwhile, Nicaragua and Moldova (middle-income countries) had to buy that same medicine at $7,424 and $9,188 respectively.

This pricing challenge will test the 2011 commitment made by UN Member States, at a UN High-level Meeting on AIDS , to place 15 million people in need on antiretroviral treatment by 2015.

Eighteen middle-income countries and stakeholders met in Brasilia in June to confront these challenges. Whether discussing intellectual property, drug registration, procurement or supply-chain management, a critical –take-away was that increasing collaboration between countries in the global South represents a key opportunity to meet common objectives.

So individually or in collaboration, how can middle-income countries confront the challenge of sustaining treatment? Of course, the experiences vary between countries, but in general, middle-income countries want to foster increased competition among medicine suppliers to reduce the cost of treatment by:

— Incorporating flexibilities found in the Agreement on Trade-Related Aspects of Intellectual Property Protection (TRIPS) into national legislation, and using them to increase competition among drug suppliers
— Developing effective regulatory frameworks for evaluating drugs’ safety and efficacy
— Promoting local pharmaceutical manufacturing
— Increasing transparency during procurement of medicines

During the meeting, UNDP made a presentation on competition law and policy’s potential as a tool to increase access to treatment. To continue to support efforts to increase access to these life-saving treatments, UNDP will be launching a guide on competition law, intellectual property and access to medicines in the next few months.